全球 2016 年因非传染性空气传播职业暴露导致的慢性呼吸道疾病负担：2016 年全球疾病负担研究的系统分析。
Global and regional burden of chronic respiratory disease in 2016 arising from non-infectious airborne occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016.
出版信息
Occup Environ Med. 2020 Mar;77(3):142-150. doi: 10.1136/oemed-2019-106013.
OBJECTIVES
This paper presents detailed analysis of the global and regional burden of chronic respiratory disease arising from occupational airborne exposures, as estimated in the Global Burden of Disease 2016 study.
METHODS
The burden of chronic obstructive pulmonary disease (COPD) due to occupational exposure to particulate matter, gases and fumes, and secondhand smoke, and the burden of asthma resulting from occupational exposure to asthmagens, was estimated using the population attributable fraction (PAF), calculated using exposure prevalence and relative risks from the literature. PAFs were applied to the number of deaths and disability-adjusted life years (DALYs) for COPD and asthma. Pneumoconioses were estimated directly from cause of death data. Age-standardised rates were based only on persons aged 15 years and above.
RESULTS
The estimated PAFs (based on DALYs) were 17% (95% uncertainty interval (UI) 14%-20%) for COPD and 10% (95% UI 9%-11%) for asthma. There were estimated to be 519 000 (95% UI 441,000-609,000) deaths from chronic respiratory disease in 2016 due to occupational airborne risk factors (COPD: 460,100 [95% UI 382,000-551,000]; asthma: 37,600 [95% UI 28,400-47,900]; pneumoconioses: 21,500 [95% UI 17,900-25,400]. The equivalent overall burden estimate was 13.6 million (95% UI 11.9-15.5 million); DALYs (COPD: 10.7 [95% UI 9.0-12.5] million; asthma: 2.3 [95% UI 1.9-2.9] million; pneumoconioses: 0.58 [95% UI 0.46-0.67] million). Rates were highest in males; older persons and mainly in Oceania, Asia and sub-Saharan Africa; and decreased from 1990 to 2016.
CONCLUSIONS
Workplace exposures resulting in COPD, asthma and pneumoconiosis continue to be important contributors to the burden of disease in all regions of the world. This should be reducible through improved prevention and control of relevant exposures.
目的
本文对全球疾病负担 2016 研究中因职业性空气暴露导致的慢性呼吸道疾病的全球和区域负担进行了详细分析。
方法
利用文献中的暴露流行率和相对风险，通过人群归因分数（PAF）来估算因职业性暴露于颗粒物、气体和烟雾导致的慢性阻塞性肺疾病（COPD）以及因职业性暴露于变应原导致的哮喘的负担。将 PAF 应用于 COPD 和哮喘的死亡人数和伤残调整生命年（DALY）。尘肺则直接根据死因数据进行估算。年龄标准化率仅基于 15 岁及以上人群。
结果
基于 DALY 的估计 PAF 分别为 17%（95%置信区间（CI）为 14%-20%）的 COPD 和 10%（95%CI 为 9%-11%）的哮喘。2016 年，因职业性空气传播风险因素导致的慢性呼吸道疾病死亡人数估计为 519000 人（95%CI 为 441000-609000）（COPD：460100 [95%CI 为 382000-551000]；哮喘：37600 [95%CI 为 28400-47900]；尘肺：21500 [95%CI 为 17900-25400]）。总的估计负担为 1360 万人（95%CI 为 1190 万至 1550 万人）；DALY（COPD：1070 万[95%CI 为 900 万至 1250 万]；哮喘：230 万[95%CI 为 190 万至 290 万]；尘肺：058 万[95%CI 为 046 万至 067 万]）。男性、老年人和主要在大洋洲、亚洲和撒哈拉以南非洲的发病率较高；从 1990 年到 2016 年，发病率呈下降趋势。
结论
导致 COPD、哮喘和尘肺的工作场所暴露仍然是世界所有地区疾病负担的重要原因。通过改进对相关暴露的预防和控制，这一情况应该可以得到改善。
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